Provider Demographics
NPI:1124405295
Name:COMMUNITY HEALTH INTERGRATED COPORATION
Entity Type:Organization
Organization Name:COMMUNITY HEALTH INTERGRATED COPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:702-793-5775
Mailing Address - Street 1:111 W JACKSON BLVD
Mailing Address - Street 2:1700
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3589
Mailing Address - Country:US
Mailing Address - Phone:702-793-5775
Mailing Address - Fax:
Practice Address - Street 1:111 W JACKSON BLVD
Practice Address - Street 2:1700
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3589
Practice Address - Country:US
Practice Address - Phone:702-793-5775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health